Healthcare Provider Details

I. General information

NPI: 1588283717
Provider Name (Legal Business Name): SOUTH ALABAMA PHYSIOTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 04/08/2020
Certification Date: 04/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16920 KOPTIS RD
SUMMERDALE AL
36580-3843
US

IV. Provider business mailing address

16920 KOPTIS RD
SUMMERDALE AL
36580-3843
US

V. Phone/Fax

Practice location:
  • Phone: 251-236-4855
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNY RESMONDO
Title or Position: OWNER/ PHYSICAL THERAPIST
Credential: MS,PT
Phone: 251-236-4855